Author + information
- Daniel W. Mudrick,
- Lynn Shaffer,
- Michelle Lalonde,
- Anirudh Ruhil,
- Greg Lam,
- Jesse Hickerson,
- Teresa Caulin-Glaser and
- Richard Snow
Cardiac rehabilitation (CR) after acute myocardial infarction (AMI) or percutaneous coronary intervention (PCI) decreases cardiac morbidity and mortality, but the effect on hospital readmission is not clear.
We identified patients with AMI and/or PCI from 2008-2009 Medicare claims data for the Columbus, OH hospital referral cluster (8,365 patients, 35 counties), and used a propensity model to match 748 CR participants and 3,804 non-participants on baseline characteristics. “Pre-CR exposure” time was defined from hospital discharge to first date of CR, and “CR exposure” from first CR to 90 days. Non-participants were assigned an exposure start date matching that of a randomly selected participant in their propensity subgroup.
CR participants had similar readmission rates (any readmission) and incidence density (readmissions/1000 patient days) to non-participants during pre-CR exposure, but significantly lower rates and incidence density during CR exposure (see Table). For patients with a readmission during the pre-CR exposure period (n=567), even greater differences in readmission rates emerged during the exposure period for CR vs. non-CR participants, 6.1% vs. 24.5% (OR = 0.20, p<0.01).
In this propensity-matched study, CR participants had lower 90-day risk of rehospitalization, with benefits seen only in the CR exposure period. Improved care transition systems to increase and speed CR enrollment may reduce rehospitalization rates.
|Cardiac Rehabilitation||No Cardiac Rehabilitation||Ratio, CR vs. No CR (95% CI)||P value|
|Any Readmission, Discharge to 90 Days||17.3%||22.8%||0.71 (0.58 – 0.87)||<0.01|
|Any Readmission, Pre-CR Exposure||11.0%||12.8%||0.84 (0.68 – 1.08)||0.18|
|Any Readmission, CR Exposure||7.0%||13.1%||0.49 (0.37 – 0.66)||<0.01|
|Incidence Density, Discharge to 90 Days||2.35/1,000 pt days||3.47/1,000 pt days||0.68 (0.57 – 0.80)||<0.01|
|Incidence Density, Pre-CR Exposure||3.94/1,000 pt days||3.62/1,000 pt days||1.09 (0.79 – 1.17)||0.23|
|Incidence Density, CR Exposure||1.57/1,000 pt days||3.40/1,000 pt days||0.46 (0.36 – 0.55)||<0.01|
“Pre-CR Exposure” is the period from hospital discharge to CR start
“CR Exposure” is the period from CR start to 90 days after hospital discharge
Mean pre-CR exposure time = 29.5 days; mean CR exposure time = 60.5 days for both groups.
Rate of Any Readmission = Patients with any readmission/total patients.
Incidence Density = Total number of admissions/patient days; may include multiple admissions per patient.
West, Room 3004
Sunday, March 10, 2013, 10:45 a.m.-11:00 a.m.
Session Title: Prevention: Clinical and Subclinical Cardiovascular Disease – Predicting Risk in 2013
Abstract Category: 26. Prevention: Rehabilitation
Presentation Number: 928-3
- 2013 American College of Cardiology Foundation